Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis |
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| Affiliation: | 1. Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, Australia;2. St. John Ambulance, Western Australia, Belmont, WA, Australia;3. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia;1. Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States;2. Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States;3. Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States;1. Department of Emergency Medicine, Medical University of Vienna, Austria;2. Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Austria;1. Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea;2. Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea;3. Department of Emergency Medicine, Dongkuk University Ilsan Hospital;4. Department of Emergency Medicine, Kyoungpook National University Hospital;5. Department of Emergency Medicine, Singapore General Hospital, and Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore;6. Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA;7. Bureau of EMS and Trauma System, Arizona State Department of Health Service, Phoenix, AZ;8. Department of Emergency Medical System, Kokushikan University, Tokyo, Japan;9. Laerdal Medical, Stavanger, Norway;1. Rescu, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada;2. Division of EMS, Public Health, Seattle & King County, Seattle, WA, USA;3. Department of Health Services, University of Washington, Seattle, WA, USA;1. Maricopa Medical Center, Department of Emergency Medicine, 2601 East Roosevelt Street, Phoenix, AZ 85008, United States;2. Bureau of Emergency Medical Services and Trauma System, Arizona Department of Health Services, 150 N. 18th Ave., Suite 540, Phoenix, AZ 85007, United States;3. Department of Emergency Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States;4. Department of Emergency Medicine, University of Arizona, PO Box 245057, 1501 N. Campbell, Tucson, AZ 85724-5057, United States;5. ZOLL Medical, 269 Mill Rd, Chelmsford, MA 01824, United States;6. Lutheran Medical Center, 8300 West 38th Avenue, Wheat Ridge, CO 80033, United States |
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| Abstract: | AimTo conduct a systematic review and meta-analysis to determine whether cardiopulmonary resuscitation (CPR) quality, as indicated by parameters such as chest compression depth, compression rate and compression fraction, is associated with patient survival from cardiac arrest.MethodsFive databases were searched (MEDLINE, Embase, CINAHL, Scopus and Cochrane) as well as the grey literature (MedNar). To satisfy inclusion criteria, studies had to document human cases of in- or out-of hospital cardiac arrest where CPR quality had been recorded using an automated device and linked to patient survival. Where indicated (I2 < 75%), meta-analysis was undertaken to examine the relationship between individual CPR quality parameters and either survival to hospital discharge (STHD) or return of spontaneous circulation (ROSC).ResultsDatabase searching yielded 8,842 unique citations, resulting in the inclusion of 22 relevant articles. Thirteen were included in the meta-analysis. Chest compression depth was significantly associated with STHD (mean difference (MD) between survivors and non-survivors 2.59 mm, 95% CI: 0.71, 4.47); and with ROSC (MD 0.99 mm, 95% CI: 0.04, 1.93). Within the range of approximately 100–120 compressions per minute (cpm), compression rate was significantly associated with STHD; survivors demonstrated a lower mean compression rate than non-survivors (MD −1.17 cpm, 95% CI: −2.21, −0.14). Compression fraction could not be examined by meta-analysis due to high heterogeneity, however a higher fraction appeared to be associated with survival in cases with a shockable initial rhythm.ConclusionsChest compression depth and rate were associated with survival outcomes. More studies with consistent reporting of data are required for other quality parameters. |
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| Keywords: | Cardiac arrest Cardiopulmonary resuscitation Quality Survival |
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